[Question #582] Ngu

92 months ago
Hi. I had correspondence for Dr Handsfield back in October last year regarding ngu from oral sex. It has been a year and  I am still suffering massively. I have taken multiple std tests and all have come out negative. I have even submitted a semen sample for pcr testing. That too was negative but I am still having some symptoms such as a feeling of discharge but nothing is there when I look. Been to the clinic many times and they say nothing is wrong. I have some questions that I would like to know the answer to if you would be so kind. 
1. Given the fact that I have tested negative for all testable std. Is this something that can harm my wife?
2. My wife and I took doxycycline when I was dx. Would this have protected her from any harmful non std bacteria. 
3. I have read numerous posts saying that ngu from oral sex is typically harmless and viewed as an inconvenience. Is this science based or just from general clinical experience?
4. I am worried that my wife could contract pid from my stupidness. Is that a concern? She has missed 2 periods and is not pregnant. 
As you can probably tell. I am having a hard time dealing with this. It is eating me up emotionally and physically. 
Thank you for your time and patience 
92 months ago
I forgot to mention. I had a semen culture done. They found no white blood cells but did find enterococcus faecalis. Can that cause ngu type symptoms?
92 months ago
Sorry about this. I know it can be messy and confusing. Just found out why missed period. My wife is 2-3 weeks pregnant. Overjoyed but still anxious about pid. Is it a realistic possibility with all the negative tests. 
Thank you. Sincerely. You provide a great service to idiots like me.  
H. Hunter Handsfield, MD
92 months ago
Welcome back to the forum. But I have to say I'm disconcerted that our previous extensive discussion, which I re-read in preparing this reply, didn't seem to do the job. I was convinced then, and remain certain, that you do not have and never had NGU or any STD. There is nothing in these new questions that changes my judgment or advice. To your specific questions:

1,4) Since you have no STD or other infection that explains your symptoms, you have nothing that can harm your wife. There is no STD known to cause missed menstrual periods -- and congratulations on your wife's pregnancy.

2) For the same reasons, there was no reason for your wife to have received doxycycline. But if you indeed had had NGU, it would have been the standard treatment for her and would have protected her from harm.

3) I have never said definitively that NGU from oral sex is harmless, only that this seems to be the case. There have never been any systematic studies of it. However, I do not recall ever seeing the partner of a man with such NGU who seemed to have any significant medical problem from it, and this also seems to be the consensus of all other STD experts. In fact, NGU in general, whether orally acquired or not, seems to be associated with rare if any apparent harm in female partners, unless due to chlamydia and maybe Mycoplasma genitalium. In any case, as I have said repeatedly, you never had symptoms that suggest NGU anyway.

It is very common to identify various intestinal or genital tract bacteria in semen or the urethra. That's what E. fecalis is, a garden variety bacteria found in everybody's rectum and/or genital tract. Absence of white blood cells is further evidence it isn't doing any harm, and I doubt it even exists in your semen per se; it is much more likely a contaminant from your penile skin or the urethral opening. I would ignore it entirely -- but if you remain concerned about it, ask the doctor who ordered the semen culture.

Finally, in response to "I am having a hard time dealing with this. It is eating me up emotionally and physically", all I can say is I and this forum have done all we can. We give the facts and probabilties as best we understand them. The rest is up to you. However, I would also point out that it is not normal to be so resistant to the repeated, reasoned, science-based reassurance you have had. It seems clear you are continuing to react emotionally to a sexual decision you regret. If those fears continue despite this additional reply, your next step should be professional counseling to help you move on. I suggest it from compassion, not criticism.

Good luck and congratulations on your coming fatherhood!  HHH, MD

92 months ago
Thanks you for your response Dr Handsfild. I Will consider it a full dressing down and will ask no further questions. I will try to move on with my life safe in the knowledge that i have no std. I am a compulsive worrier and find it difficult to let got of things and relax but i WILL try. I have a follow up appointment with a urologist in a few weeks that i will attend as i still get aches and pains in anus and perenium and wake in the middle of the night to go the toilet. As you have said and i suspect is true, it could just be down to anxiety. 
I know people tell you all the time that you do a great job. You really do!
Thank you for your time. I will not follow up with any further questions unless visit to urologist throws further spanners in the works.
H. Hunter Handsfield, MD
92 months ago
My comments certainly were not intended as a "dressing down" -- just blunt statements of facts and probabilities. But thanks for the thanks; I'm truly glad to have helped. Best wishes and stay safe.

92 months ago
So i have had my follow up with urologist. He is going to prescribe 4 weeks augmentin for the enterococcus that was found on the semen culture. The antibiotic sensitivity states ampicillin. I know augmentin has amoxicillin in it. He said it is basically the same   Really?
If you would indulge me.  I would like to ask a few more questions. 
1. I still have a little puffiness and redness of my meatus. It settles down a lot if I apply canisten hc cream to it.  Is this indicative of an std or more of yeast/thrush?
2. When I ejaculate. If i am not scrupulous with hygiene afterwards, the meatus will often be very red and puffy and urethra will itch slightly inside. What causes this. It's not something new to me as I have noticed this for many years but it is more pronounced since the onset of my symptoms  
3. It been over a year now. I know you have said that this is not ngu but if somehow it was, would the 6weeks of cipro, the doxy and azithromycin took care of it and would it have run its course naturally ? As you can probably tell, I am extremely worried as I have so much to lose. 
Finally. I know the dialog is closed after 2 responses but I was hopeful that you would leave it open so I can report back after the course of augmentin. I don't want or expect you to answer any subsequent questions after this one. It will only for the benefit of other people who may read our interaction. 

Many thanks Dr. All the best 
H. Hunter Handsfield, MD
92 months ago
Thanks for the follow-up information.

Ampicillin, amoxicillin and Augmentin:  Your doctor is exactly right. Amoxicillin is a minor chemical change from ampicillin, which is used in the lab to test bacterial susceptibility to amoxicillin. Augmentin is amoxicillin plus clavulanic acid, which makes the drug more effective against some bacteria. It doesn't have that particular benefit against enterococcus, but is marketed in a larger dose, allowing twice daily instead of 3-4X daily dosing. The expanded bacterial coverage also might benefit other bacteria that can contribute to prostate and other internal urinary tract infections, but which might have not shown up on the culture. It will be just as effective as amoxicillin or ampicillin would be, and is exactly what I would prescribe in this situation.

1) It isn't possible to judge this given the response to Canestin HC. The HC stands for hydrocortisone, which reduces inflammation of any cause. If you try plain Canestin (without the HC) and the symptoms still respond, it would favor a yeast infection. In any case, this sounds harmless and nothing to worry about. In any case, this is best discussed with your urologist.

2) I can't say why these symptoms might happen. It's not an STD issue and not something I've ever dealt with in my own patients. Your urologist is in a better position to answer this.

3) The new information doesn't change my opinion or advice about NGU or STDs. For sure this is not NGU and never was. You need to work on your obsession about it. Not all genital problems are STDs or related to sexual behavior and exposures.

Thanks for the thanks and for your kind comments about our services. But since this isn't an STD and hence off topic for this forum, I'm going to ask that you not post any more questions about this situation. Best of luck for speedy recovery.